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Article History

Received: 5 February 2025

Revised: 2 May 2025

Accepted: 14 May 2025

First Online: 21 October 2025

Ethics declaration

: HE, IW, SSZ, SA, AH, GH and IY report no conflicts of interest. UA has received honoraria from Viatris, Grünenthal, Eli Lilly, Procter & Gamble for educational meetings and has received investigator-led funding from Procter & Gamble. UA has received sponsorship to attend educational meetings from Daiichi Sankyo and Sanofi. GYHL is a National Institute for Health and Care Research (NIHR) Senior Investigator. He is Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos (no fees are received personally). He is co-PI/lead of the AFFIRMO project on multimorbidity in AF (grant agreement no. 899871), TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement no. 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement no. 101080189), which are all funded by the EU's Horizon Europe Research & Innovation programme. GH is a full-time employee of TriNetX LLC. The TriNetX platform is a federated network that provides access only to de-identified data, and analyses performed on the platform do not require ethical approval or informed consent. This is accordance with all data protection laws applicable to the underlying healthcare organisations (HCOs), including the EU General Data Protection Regulation (Regulation 2016/679, GDPR) and the US Health Insurance Portability and Accountability Act. Written informed consent to participate in this study is not required in accordance with the relevant legislation. Network analytics are performed locally at each participating HCO, with only aggregate counts and statistical summary results being returned to the TriNetX platform. The platform does not provide access to any personal data or protected health information, ensuring that individual patients cannot be identified. All participating HCOs affirm that they have the necessary rights, consents, approvals, and authority to share de-identified data with TriNetX under a business associate agreement for research purposes. Because our research involves only secondary analysis of de-identified, aggregate data with no direct patient interaction or identifiable private information, it is considered exempt from institutional review board or ethics committee review under applicable regulations.